We have found diabetes is associated with poorer cognitive function than persons without diabetes, and that these associations are mediated by cerebral small vessel disease. Collaborations continue in the context of consortia for genetic studies that examine the genetics of diabetes-related co-morbidity including kidney function. ACCORD-MIND is funded through an intra-agency agreement between NHLBI and NIA. It is a sub-study nested within the randomized factorial clinical trial - Action to Control Cardiovascular Risk in Diabetics (ACCORD). ACCORD evaluates whether more intensive glucose, blood pressure and lipid management can reduce cardiovascular disease in people with diabetes. ACCORD-MIND is embedded in a sub-sample of ACCORD participants. The primary aim of the MIND sub-study was to test whether the rate of cognitive decline and MRI-based structural brain change in people with diabetes treated with standard care guidelines is different than in people with diabetes treated with intensive care guidelines. Final results on the trial are published. The trial showed no differences in 40-month cognitive test scores between those on intensive vs. standard treatment. The cognitive results were similar for the blood pressure and lipid interventions. On the other hand, in the MRI study, those on the intensive glycemic treatment had less decline in total brain volume than the standard treatment group. In the blood pressure trial total brain volume decreased less in the standard treatment group. Other clinical insights based on the ACCORD MIND trial include the role of poor cognition on increasing the risk for hypoglycemia, the lack of association of hypoglycemia on brain atrophy, the association of diabetes and depression, the association of diabetic retinopathy and future cognitive decline. We found no differences in cognition or brain structure in the ACCORDION follow-up, Research in the CARDIA Brain MRI Sub-study shows in middle-age, adverse brain changes begin in persons with diabetic levels of fasting glucose, and the main changes are in the gray matter.